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Since patient complexity is a major determinant of expenditure, in order to control drug costs more effectively and with equity, methods for case mix adjustment should be considered.
It estimates individual health status and risk for health service use based on age, gender and diagnoses assigned over a defined time interval, typically one year. Each diagnosis is assigned to one of 32 aggregated diagnostic groups (ADGs). Each ADG is a cluster of similar conditions based on their expected impact on health services resource consumption. Patients are then classified into one ACG based on age, gender and constellation of ADGs.